First ICO pilots to go live within weeks

The first integrated care organisation (ICO) pilots will begin before the end of this year, with some expected to go live next month.

Hailed as being the biggest influence on PBC over the next year, the DH has already put together a draft prospectus for applicants asking them to state their earliest implementation date – adding that ‘this is expected to be before the end of 2008'.

Dr James Kingsland, chair of the NAPC, said he was unsurprised by the timescale, which he described as ‘not unreasonable'.

He said: ‘If it is an ICO that requires you to develop and decide a new organisation then that's probably a bridge too far. But if there's a PBC cluster that already has a well-functioning group of practices then they can hit the ground running.'

The prospectus also says it wants the pilots to bring about a ‘step change' in the quality of health and social care by creating evidence on what will improve the NHS. All pilots will be subject to a three-year independent evaluation requiring them to submit data to nationally agreed criteria.

Other details to emerge in the prospectus are:

• the number of pilots will be determined by the quality of proposals

• all proposals will have to be around populations registered for medical services

• DH grants for pilots will be dependent upon the size of the pilot and its precise content.

Dr Kingsland said the draft prospectus made clear there was no ‘one-size-fits-all' approach to what the DH wanted to achieve.

He said: ‘You might have a small PBC group doing one ICO project with social care and then there might be a large organisation looking after 10 times that population size working on providing far more wide-ranging services.

‘The prospectus is pretty permissive.'

Dr Mike Dixon, NHS Alliance chair, agreed the prospectus was ‘pretty open' and that in some pilots consultants and generalists would work together ‘cheek by jowl' with other community services, akin to the US Kaiser Permanente model providing total healthcare for patients with the exception of acute tertiary care.

At the other end of the spectrum, there would be secondary and primary care organisations looking at a single care pathway together.

Dr Kingsland reiterated that all ICOs had to be based around registered lists and that GPs would therefore need to be involved in the pilots.

He said: ‘The custodian of the practice list is the general practice.

‘PCTs might argue they have an out-of-hours list – but in-hours those patients are registered with that practice.

‘This not about producing an ICO for a geographic area. It is an ICO for a particular group of patients.'

Some 150 people attended a DH workshop last month to develop the prospectus, with more than 250 having applied for places. So far 520 people have signed up to receive regular DH updates on ICOs.